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a man taking medication imageNovember 10 2017

Doxycycline should not be used for post-exposure prophylaxis (PEP) for sexually transmitted infections, says new guidance. Any potential benefits are “outweighed by the considerable potential for antibiotic resistance to develop in STIs and other bacteria.”

Members of the public who may be searching online for doxycycline PEP should be advised that antibiotics should only be prescribed by a health professional and use diagnostic testing.

A position statement issued jointly by Public Health England and the British Association for Sexual Health and HIV (BASHH) says more research is needed to assess the wider impact of prophylactic doxycycline on antimicrobial resistance (AMR) at an individual and population level. Instead, the organisations state: “We recommend the use of antibiotics as prescribed by a healthcare professional and as indicated by the results of a suitable diagnostic test.”

The statement refers to a study published earlier this year which had found that doxycycline PEP had halved the rates of bacterial STIs in men who have sex with men (MSM), in an extension of the French IPERGAY trial. “Many of the online companies selling HIV Pre-exposure Prophylaxis (PrEP) in the form of tenofovir disoproxil fumarate 300mg / emtricitabine 200mg are now making doxycycline available to UK buyers,” says the statement.

“A high rate of STIs without doxycycline PEP was shown (69.7 events per 100-person years of follow-up) and the antibiotic strategy showed an overall reduction in STI incidence of 47%. There was a significant decrease in chlamydia and syphilis incidence with reductions of 70 and 73% respectively in intent to treat analyses but no clear benefit was shown for gonorrhoea, likely due to the high rate of doxycycline resistance already developed.”

The PHE /BASHH statement adds: “For those at risk, following condomless sex, we recommend STI testing at appropriate window periods and the treatment of any infections identified should be prescribed by a healthcare professional and be in line with published national guidance. We recommend that the use of doxycycline PEP should be restricted to the research setting at present.”

Links:
PHE announcement       
BASHH announcement  
PHE/BASHH ‘Position Statement on Doxycycline as PostExposure Prophylaxis for Sexually Transmitted Infections’ November 2017                  

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